2024 Luis Villalobos Award-Company Application
Company Name
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Company Headquarters: State / Province
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Contact Person / Title
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Email
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Phone Number
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-
Area Code
Phone Number
Website
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Category (choose one):
Life Sciences (Pharma, Med devices, HealthCare IT, Digital or Mobile Health, etc.)
Technology, Services, & Consumer: (Hardware & Software, Social Media, Web 2.0., Fintech, AgTech, etc.)
Year Company Founded:
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Number of Employees (FTE):
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Funding Dollars Raised to date: Non-dilutive
Funding Dollars Raised to date: Equity
Lead Investor on your last round:
At your current running rate, what are your annual revenues?
Pre-Revenue
$0 - $500,000
$500,000 - $1 million
$1 - $3 million
$3 - $5 million
Over $5 million
Explain the problem your idea addresses (100 words max)
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0/100
Explain your solution and how it is exceptionally ingenious, creative, and innovative - especially versus other solutions (max 300 words):
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0/300
What is the Serviceable Addressable Market (SAM) inUSD? (max 50 words)
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0/50
How has this company demonstrated progress toward implementing your solution? (max 200 words):
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0/200
What is the proprietary or the source of your defensibility?
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0/100
What makes you and your team uniquely able to execute on your plan?
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0/100
Do you have any partners that you are working with? Who and why?
0/100
Targeted Exit: Discuss your exit strategy including type of exit possible, path toexit, timing, additional investment dollars needed to reach exit, core valueyou provide to potential acquirers. (max 300 words)
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0/300
Name of Nominating ACA member / group
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By submitting this application for consideration of the 2024 Luis Villalobos Award, I understand that the company name will be noted in the public information for the award and, should my company be named a category winner one person from the company will attend the award ceremony in Columbus, OH May 14, 2024
Affirmed
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